Editor’s note: This is the third in a series of stories examining the impact of state budget cuts on public health agencies serving the Allen County area.

By SUSAN LYNN
Register Editor

Register/Susan Lynn
Donna Scott, left, and JoAnne Buche have developed a sisterly relationship over the nine years that Scott has worked as a personal care attendant for Buche.

JoAnn Buche lives with constant fear she will be forced into a nursing home.
Buche, 74, is confined to a wheelchair because of an amputated leg and severe arthritis that makes using crutches impossible. She’s able to remain in her home because round-the-clock attendants see to her wellbeing.
Meticulous about personal cleanliness, Buche requests being helped to bathe every day. “If I don’t, you know I’m really sick,” she said.
The idea of being bathed only twice a week, “is unthinkable,” she said of the limited services of a nursing home.
The personal care attendants who help Buche with meal preparation, toileting needs, medications, transportation and housecleaning are secured through the Southeast Kansas Area Agency on Aging. The program that provides the services is the Home and Community Based Services and is funded by Medicaid.
But recent cuts have suspended many services that enable people like Buche to remain in their homes.

JOHN GREEN, executive director of the Chanute-based Agency on Aging, said “it’s tough” to keep his optimism intact.
“Surely we’ve seen the worst, or are getting near it,” he said of the state’s financial crisis.
It’s his job to see that the area’s elderly receive adequate care and nutrition through myriad programs including Meals on Wheels, home-based services and senior health insurance counseling. Yet due to recent cuts by the state, the needs of area seniors are going unmet.
Today the agency is operating at 2005 funding levels. For fiscal year 2009, which ended in September, the agency’s $3.5 million budget was slashed by $100,000.
Since the first of the year it has seen further cuts and suspension of certain services.
The agency has coped so far by reducing services, not replacing three recently vacated positions and freezing salaries for the last two years. Over the last four years SEKAAA employees have received one 3-percent raise. That was two years ago.
“We have a very dedicated staff,” Green said of his employees.
When he accepted the position of executive director five years ago, it was in addition to his position with the Older Kansas Employment Program — helping senior citizens find jobs.
EARLIER THIS MONTH, four services included in the HCBS waiver were “suspended indefinitely,” by the state. They are:
* Assistive technology — A service that pays for mobility devices such as wheelchairs or items such as lift chairs or bath benches as well as funding for remodeling to make a home handicap-accessible.
* Comprehensive support — For people who have Alzheimer’s or dementia and need in-house care to see they are safe and don’t wander off.
* Sleep/Cycle support — Overnight care that tends to clients’ needs during the night.
* Oral health — Helps pay for dentures or other dental health care.
Canceling these services not only endangers the elderly and handicapped, it forces them prematurely into nursing homes, Green said. And that is a much more expensive option for U.S. taxpayers, he noted.
“A person staying in their home receving our care costs about $1,200 a month, or $14,400 a year,” Green said. “Moving them into a nursing home costs about $3,000 a month — and that’s on Medicaid.” Private pay is closer to $4,000 a month, or almost $50,000 a year.
“Nursing home expenses spend down a family’s income to nothing, forcing the state to then pick up the tab,” Green said. “It’s a classic example of a short-term gain for a long-term loss.”

FOR BUCHE, being able to stay in her home means she can remain productive.
An avid seamstress, Buche quilts and sews several hours a day. She does scrapbooking. She also cooks with the help of longtime personal care attendant Donna Scott.
Scott, 66, is an employee of Windsor At-Home Care and tends to Buche three days a week. Over their nine-year relationship Buche and Scott have become close friends.
“We’re more like sisters,” Buche said. “We cook alike. We think alike. We even have daughters both named Jackie.”
“JoAnne continues to thrive because of Donna’s care,” said Nancy Maier, SEKAAA case manager for Buche.
“Their friendship means that Donna goes above and beyond what is expected of her job. These attendants are not well-paid to begin with. Though they’ve all received 10 percent pay cuts, many still give the same amount of care, if not more.”
The cuts also threaten the viability of personal care attendance as a job, Maier said, “which would really damage the program.”
In Allen County, 12 people have lost HCBS services, Maier said.
Maier is one of 15 case managers who routinely visit 1,385 elderly in their homes ensuring they receive proper care and their home environment is safe.
THE 10 PERCENT cuts were through Medicaid, the state and federally funded service that provides health care to the indigent and handicapped. Statewide, Kansas has 300,000 low-income citizens who depend on Medicaid services. HCBS cuts directly affect 550 Kansas.
Reducing Medicaid payments by 10 percent means more than trimming a program by the equivalent amount. For every 30 cents contributed by the state, the federal government contributes 70 cents. Thus, cutting state dollars 10 percent equates to a larger loss of federal funds.
The cuts affect everyone, from clients to service “connectors” like the Southeast Kansas Area Agency on Aging to physicians, nursing homes and hospitals. For the elderly dependent on state aid, it’s particularly bad timing, because the state’s financial catastrophe “comes at a time when the nation’s elderly is expanding exponentially,” Green said. “It’s a double whammy.”
Green empathizes with Kansas legislators and their challenge to adequately fund their responsibilities to Kansans.
“I understand the dilemma they’re in,” he said. “But what human toll are you willing to pay?”
In defense of Kansas lawmakers, Green lauded their commitment to the Senior Care Act established in 1989.
“Kansas was an exception to the rule in providing this act,” Green said. “Historically, it’s been great for the state.”
The act, Green said, allowed for providing services for those who “fall through the cracks. The people who don’t qualify for Medicaid, but don’t have the resources to afford the services they need.” These clients receive one to four hours of personal or housekeeping care a week.
Since 2006, the Act’s funding has been whittled by $160,000, Green said, leaving the prospect for taking on more clients in serious doubt.
Green’s nine-county district serves almost 20 percent of those who benefit from the Senior Care Act; 51 more are on a waiting list.
“Our legislators are faced obviously with the very important job of prioritizing,” Green said. “And I would hope adequately funding services for the poor and elderly and education for our children would be deemed vital to our state’s future.”
As for SEKAAA, Green said, “Our goal is to keep older Kansans living in their homes with pride and dignity.”